THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rod@welchco.com
S U M M A R Y
DIARY: May 8, 2014 11:33 AM Thursday;
Rod Welch
VA full lab Labcorp with lipid panel test cholesterol for LDL-P discordance.
1...Summary/Objective
2...CBC WBC 9.5 Increased 50% After Several Years Stable
3...Blood Tests Evaluate Health 5 Years After CABG x4 Surgery
........CBC........... 2014 05 08 1149 140203 140201 130529
4...Urinalysis Gross Exam Laboratory Test Satisfactory Within Range
5...Ketones Abnormal May Reflect Burning Fat with Extended Exercise
........URINALYSIS.....2014 05 08 1149 140203 140201 120509
6...Notes on Urinalysis Lab
7...Total Bilirubin 1.3 Improvement Low Dose Atorvastatin Ezetimibe
8...Hyperbilirubinemia Improved Low Dose Atorvastatin Ezetimibe
9...Potasium K 5.6 Elevated Increased Electrical Problems Heart
10...Bun/Creatinine Ratio Elevated Slightly
...........................ELECTROLYTES - CHEM PROFILE
11...Notes on Electrolytes Lab
12...LDL-C 83 LDL-P 851 LDL Size Large Hike 900 Miles Weight Lose 15 Pounds
........LIPID Panel....2014 05 08 1149 140203 140201 131015 130529
13...Lipid History Trend Analysis
14...Coronary CTA or IVUS Test Athereosclerosis Plaque 4 Years After CABG
15...Athereosclerosis Plaque 4 Years After CABG Coronary CTA or IVUS Test
16...Myopathy Muscle Pain Side Effects Simvistatin Decline
.............................CARDIAC ENZYMES
17...HGBA1c Diabetes Blood Test
18...Diabetes Blood Test HGBA1c
.............................HGBA1c
ACTION ITEMS..................
Click here to comment!
1...What might elevate WBC 50%?
2...Need comment from VA on Ketones and Specific gravity labs.
CONTACTS
SUBJECTS
CBC Lab WBC 9.5 Labcorp Blood Test Results
2303 -
2303 - ..
2304 - Summary/Objective
2305 -
230501 - Follow up ref SDS 49 0000. ref SDS 48 0000.
230502 -
230503 - Labcorp blood test today found WBC 9.5 suddenly increased 50% compared
230504 - to prior patient history. ref SDS 0 RP4N Urinalysis reported Ketones
230505 - Trace Abnormal, and specific gravity elevated. ref SDS 0 MT4L
230506 - Electrolyte profile reported glucose and sodium increased. Potassium
230507 - 5.6 increased above range, ref SDS 0 KK9M, which presents risk of
230508 - "electrical problems for heart. ref SDS 0 TN3M These elevated labs
230509 - may be caused by dehydration from increased urination associated with
230510 - taking statin medication, and compounded by extended hiking exercise.
230511 - ref SDS 0 KZ5O Bilirubin decreased, but remains above range,
230512 - ref SDS 0 015M, presenting risk of liver damage from taking statin
230513 - medication. ref SDS 0 G34G Lipids improved again, with LDL-P 851
230514 - falling from 861, HDL 67 increasing from 61, and Triglycerides 59
230515 - falling from 68. ref SDS 0 U45J Indicates good response to VA
230516 - Healthcare prescribing Atorvastatin 10mg and Ezetimibe 10mg, while
230517 - hiking 1000 miles since prior lab on 140201, controlling weight with
230518 - low carb diet, and continuing daily orange juice.
230520 - ..
230521 - [On 140510 2056 received letter from Health Testing Centers
230522 - transmitting report on lab results. ref SDS 55 4Q6I
230524 - ..
230525 - [On 140514 0950 lab at VA Medical Center in San Francisco,
230526 - which omits NMR lipid testing, CBC, and Electrolytes.
230527 - ref SDS 57 X45G
230529 - ..
230530 - [On 140515 2043 VA notified consolidated test results show
230531 - progress lowering CVD risk with improved lipid management.
230532 - ref SDS 60 IM9N
230533 -
230534 -
230536 - ..
2306 -
2307 -
2308 - Background
2309 -
230901 - On 131016 1632 submit letter for agenda meeting to review lab results
230902 - scheduled 131017 1000. ref SDS 34 X45G
230904 - ..
230905 - On 140131 0815 ordered another lab - cbc, electrolytes, lipid with NMR
230906 - - from Labcor to get LDL-P. ref SDS 47 X45G
230908 - ..
230909 - On 140201 1159 had full lab with NMR lipid panel drawn at John Muir
230910 - Hospital on Treat, and by Labcorp. ref SDS 48 RP4N
230912 - ..
230913 - On 140203 1147 had partial lab drawn at VA in Martinez. ref SDS 49
230914 - KK9M
230916 - ..
230917 - On 140507 0857 ordered another full lab with NMR lipid panel.
230918 - ref SDS 54 OO5G
230919 -
230920 -
230921 -
230922 -
230923 -
230925 - ..
2310 -
2311 -
2312 - Progress
2313 -
231301 - Yesterday, placed lab order # 29443 with Health Testing Centers,
231302 - reported on 140507 0857. ref SDS 54 OO5G and confirmed with the letter
231303 - later that day, also shown on 140507 0857. ref SDS 54 XW7M This
231304 - implemented work plan in the record of prior VA lab on 140203 1147.
231305 - ref SDS 49 IL7N
231307 - ..
231308 - Today, drove to Labcorp, and met with Mark at...
231309 -
231310 - LABCORP
231311 - John Muir Medical Center
231312 - 1450 TREAT BLVD. WALNUT CREEK, CA 94595
231313 - Phone:925-937-1954 Hours:MONDAY-FRIDAY 6:30AM-9:00PM
231314 - SATURDAY 8:00AM-5:00PM
231315 - SUNDAY 9:00AM-5:00PM
231317 - ..
231318 - Mark found order # 29443 on Labcorp computer that was placed
231319 - yesterday, ref SDS 54 OO5G, and following up prior blood test at
231320 - Labcorp on 140201 1159. ref SDS 48 XO6J
231321 -
231322 - Patient Identification
231329 - ..
231330 - Order Code
231331 - 001545 Alanine Aminotransferase (ALT/SGPT)
231332 - 319417 CMP12 + 8AC + CBC/D/Plt + UA
231333 - 884247 NMR LipoProfile
231335 - ..
231336 - Total cost................ $188 .... 140507 0857, ref SDS 54 LH52
231338 - ..
231339 - Mark performed blood draw for following labs...
231340 -
231341 - [On 140510 2056 received letter from Health Testing Centers
231342 - transmitting report on lab results. ref SDS 55 4Q6I
231343 -
231344 - [On 140514 0950 lab at VA Medical Center in San Francisco,
231345 - which omits NMR lipid testing, CBC, and Electrolytes.
231346 - ref SDS 57 X45G
231347 -
231348 -
231362 - ..
231363 - CBC WBC 9.5 Increased 50% After Several Years Stable
231364 - Blood Tests Evaluate Health 5 Years After CABG x4 Surgery
231365 -
231366 - Follow up ref SDS 49 RP4N, ref SDS 48 RP4N.
231367 -
231368 - Prior VA CBC on 120509 1108. ref SDS 20 RP4N
231369 - Prior VA CBC on 120831 1524. ref SDS 21 RP4N
231370 - Prior VA CBC on 121130 1001. ref SDS 25 RP4N
231371 - Prior VA CBC on 130529 0818. ref SDS 31 RP4N
231372 - Prior Labcorp CBC on 140201 1159. ref SDS 48 RP4N
231373 - VA did not order CBC for lab on 140203 1147. ref SDS 49 YX8K
231374 - Prior Labcorp CBC on 140508 1149. ref SDS 0 RP4N
231376 - ..
231377 - CBC........... 2014 05 08 1149 140203 140201 130529
231378 - Labcorp VA Labcorp VA VA Labcorp
231379 - Blood Results Results Results Results Units Range Range
231380 - WBC 9.5 6.2 7.4 K/cmm 4.8 - 10.8 3.4 - 10.8
231381 - RBC 5.21 5.13 5.09 M/cmm 4.7 - 6.1 4.14 - 5.80
231382 - HGB 15.1 15.2 15.0 g/dL 14 - 18 12.6 - 17.7
231383 - HCT 47.0 44.2 46.2 % 42 - 52 37.5 - 51.0
231384 - MCV 90.0 86.0 90.7 fL 80 - 99 79.0 - 97.0
231385 - MCH 29.0 29.6 29.5 uug 27 - 34 26.6 - 33.0
231386 - MCHC 32.1 34.4 32.5 gm/dL 32 - 35.2 31.5 - 35.7
231387 - RDW 13.8 13.7 14.4 % 11.5 - 14.5 12.3 - 15.4
231388 - PLT 329 303 279 K/cmm 130 - 400 155.0 - 379.0
231389 - MPV 8.8 fL 7 - 10.4
231390 - NEUT % 70 69 69.9 % 40 - 80 40.0 - 74.0
231391 - LYMPH % 20 21 L 19.7 % 20 - 51 14.0 - 46.0
231392 - MONO % 8 8 7.8 % 2 - 13 4.0 - 12.0
231393 - EOS % 1 1 1.9 % .5 - 7 0.0 - 5.0
231394 - BASO % 1 1 0.7 % 0 - 2 0.0 - 3.0
231395 - NEUT # 6.7 4.3 5.2 K/cmm 1.5 - 7.9 1.4 - 7.0
231396 - LYMPH # 1.9 1.3 1.5 K/cmm 1.2 - 3.4 0.7 - 3.1
231397 - MONO # 0.7 0.5 0.6 K/cmm .2 - 1.2 0.1 - 0.9
231398 - EOS # 0.1 0.1 0.1 K/cmm .1 - .5 0.0 - 0.4
231399 - BASO # 0.1 0.1 0.1 K/cmm 0 - .2 0.0 - 0.2
231400 - ESRmVES mm/hr 0 - 10
231401 - ESRxCYT mm/hr 2 - 10
231402 - RETIC % % .66 - 2.85
231403 - RETIC # k/uL 27.9 - 121.6
231404 - Immature Granulocytes 0.0 0.0 % 0.0 - 2.0
231405 - Immature Grans (Abs) 0.0 0.0 % 0.0 - 0.1
231407 - ..
231408 - Comments:
231409 -
231410 - a. Test Performed at...
231411 - Health Testing Centers
231412 - 2760 W. OAKLAND PARK BLVD.
231413 - FORT LAUDERDALE FL 33311
231415 - ..
231416 - What might elevate WBC 50%?
231418 - ..
231419 - Increased exercise explained below, ref SDS 0 I17G, may have
231420 - stimulated bone marrow to produce more new blood that elevated WBC,
231421 - explained by Doctor Johnson during a meeting at Kaiser on 030606.
231422 - ref SDS 1 JP7G
231423 -
231424 - [On 140514 0950 VA lab did not include CBC, so cannot cross
231425 - check WBC 50% increase in Labcorp test. ref SDS 59 FK6I
231426 -
231427 -
231428 -
231429 -
231430 -
231431 -
2315 -
SUBJECTS
Urinalysis Gross Exam Laboratory Test Satisfactory Within Range Labc
3503 -
350401 - ..
350402 - Urinalysis Gross Exam Laboratory Test Satisfactory Within Range
350403 - Ketones Abnormal May Reflect Burning Fat with Extended Exercise
350404 -
350405 - Follow up ref SDS 49 0X72, ref SDS 48 0X72.
350406 -
350407 - Prior Urinalysis test on 101207 0906. ref SDS 9 0X72
350408 - Prior Urinalysis test on 120509 1108. ref SDS 20 0X72
350409 - Prior Urinalysis test on 140201 1159. ref SDS 48 0X72
350410 - VA did not order urinalysis for lab on 140203 1147. ref SDS 49 0X72
350411 - Prior Labcorp CBC on 140508 1149. ref SDS 0 0X72
350413 - ..
350414 - URINALYSIS.....2014 05 08 1149 140203 140201 120509
350415 - Labcorp VA Labcorp VA VA Labcorp
350416 - Results Results Results Results Units Range Range
350417 - PH 5.5 5.5 6.0 5 - 9 5.0 - 7.5
350418 - PROTEIN NEG NEG NEG mg/dL NEG - TRACE NEG - TRACE
350419 - GLUCOSE NEG NEG NEG mg/dL Ref: NEG NEG
350420 - KETONES Trace Abnormal NEG NEG mg/dL Ref: NEG NEG
350421 - BILI NEG NEG NEG Ref: NEG NEG
350422 - BILIcnf Ref: NEG
350423 - BLOOD TRACE TRACE TRACE Ref: NEG
350424 - NITRITE, URINE NEG NEG NEG Ref: NEG NEG
350425 - UROBILI 0.2 0.2 0.2 EU/dL .2 - 1 0.0 - 1.9
350426 - LEU EST NEG Ref: NEG
350427 - SP.GRAV H 1.036 1.026 1.025 1.003- 1.035 1.005 - 1.030
350428 - COLOR YELLOW YELLOW YELLOW
350429 - APPEAR CLEAR CLEAR CLEAR
350430 - WBC ESTERASE NEG NEG
350431 - OCCULT BLOOD NEG NEG NEG
350433 - ..
350434 - Comments:
350435 -
350436 - a. Test Performed at...
350437 - Health Testing Centers
350438 - 2760 W. OAKLAND PARK BLVD.
350439 - FORT LAUDERDALE FL 33311
350440 -
350442 - ..
350443 - Notes on Urinalysis Lab
350444 -
350445 - Internet research seems to indicate Ketones trace abnormal may occur
350446 - with dehydration. Customer hiked 1000 miles the past 3 months, hiked
350447 - 22 miles yesterday, and another 11 miles this morning before the lab,
350448 - possibly causing some dehydration, reported in case study on 120101
350449 - 0900. ref SDS 15 4G5I
350450 -
350451 - [On 140608 1056 article reporting fasting increases WBC to
350452 - strengthen immunity; comment explains when body burns fat
350453 - tissue for fuel, ketones begin to flow. ref SDS 65 G847
350455 - ..
350456 - Need comment from VA on Ketones and Specific gravity labs.
350457 -
350458 -
350459 -
350460 -
350461 -
350462 -
350463 -
3505 -
SUBJECTS
Lab Electrolytes Chem Profile Glucose 97 Sodium NA 144 Potasium K 5.
5203 -
520401 - ..
520402 - Total Bilirubin 1.3 Improvement Low Dose Atorvastatin Ezetimibe
520403 - Hyperbilirubinemia Improved Low Dose Atorvastatin Ezetimibe
520404 - Potasium K 5.6 Elevated Increased Electrical Problems Heart
520405 - Bun/Creatinine Ratio Elevated Slightly
520406 -
520407 - Follow up ref SDS 49 KK9M, ref SDS 48 KK9M.
520408 -
520409 - Good results today align with increased hiking and weight loss past 3
520410 - months, reported in case study on 120101 0900, ref SDS 15 LO5O, and
520411 - reflect changes in diet with adding minimal medication, reported on
520412 - 140202, in the same study. ref SDS 15 GH4M
520414 - ..
520415 - Prior CHEM PROFILE on 120509 1108. ref SDS 20 KK9M
520416 - Prior CHEM PROFILE on 120831 1524. ref SDS 21 KK9M
520417 - Prior CHEM PROFILE on 130228 1140. ref SDS 29 KK9M
520418 - Prior CHEM PROFILE on 130529 0818. ref SDS 31 KK9M
520419 - Prior CHEM PROFILE on 131015 0724. ref SDS 33 KK9M
520420 - Prior CHEM PROFILE Labcorp on 140201 1159. ref SDS 48 KK9M
520421 - Prior CHEM PROFILE on 140203 1147. ref SDS 49 KK9M
520422 - Prior CHEM PROFILE Labcorp on 140508 1149. ref SDS 0 KK9M
520423 -
520424 - [On 140510 2056 received letter from Health Testing Centers
520425 - transmitting report on lab results. ref SDS 55 4Q6I
520427 - ..
520428 - ELECTROLYTES - CHEM PROFILE
520430 - ..
520431 - CHEM PROFILE...2014 05 08 1149 140203 140201 131015 130529
520432 - Labcorp VA Labcorp VA VA VA Labcorp
520433 - PLASMA Results Results Results Results Results Units Range Range
520434 - GLUCOSE 97 103 98 108 H 120 mg/dL 74 - 118 65.0 - 99.0
520435 - GLUfast mg/dL Ref: <=99
520436 - NA (salt) 144 140 140 139 139 mmol/L 136 - 144 134.0 - 144.0
520437 - K (potasium) H 5.6 H 5.4 4.8 4.3 H 4.9 mmol/L 3.4 - 4.8 3.5 - 5.2
520438 - CL 105 103 102 105 105 mmol/L 98 - 106 97.0 - 108.0
520439 - CO2 30.0 37.0 30.0 mmol/L 23 - 33
520440 - BUN/Creati Ratio H 23 17 20 24 18 mg/dL 8 - 26 10.0 - 22.0
520441 - CREAT 0.97 0.82 0.81 0.83 0.83 mg/dL .5 - 1.1 0.76 - 1.27
520442 - eGFR INA 79 >60 91 >60 >60 mL/min Ref: >=60 >59
520443 - eGFR IA 92 106 mL/min >59
520444 - CALCIUM 9.5 9.3 9.4 9.2 9.2 mg/dL 8.7 - 10.2 8.6 - 10.2
520445 - CA CORR mg/dL 8.7 - 10.2
520446 - PO4 mg/dL 2.4 - 4.5
520447 - MG 85 mg/dL 1.8 - 2.5
520448 - ALK PHO 100 105 84 87 IntUnits/L 37 - 107 39.0 - 117.0
520449 - ..
520450 - T. BIL H 1.3 H 2.1 H 1.6 H 1.7 H 1.3 mg/dL .3 - 1.2 0.0 - 1.2
520451 - D. BILI 0.32 0.3 0.34 < 0.1 mg/dL .1 - .4 0.00 - 0.40
520452 - Bilirubin, Indir 0.98 1.26 H mg/dL 0.10 - 0.80
520453 - AST 26 23 21 20 22 IntUnits/L 8 - 42 0.0 - 40.0
520454 - ALT 17 21 19 17 19 IntUnits/L 5 - 55 0.0 - 44.0
520455 - ALBUMIN 4.6 4.1 4.4 3.9 4.0 g/dL 3.3 - 4.8 3.6 - 4.8
520456 - PROTEIN 6.6 6.7 6.5 7.1 7.2 g/dL 6.5 - 8.1 6.0 - 8.5
520457 - Globulin, Total 2.0 2.1 g/dL 1.4 - 4.5
520458 - A/G Ratio 2.3 2.1 1.1 - 2.5
520459 - LDH 200.0 180.0 IntUnits/L 90 - 208 0.0 - 225.0
520460 - GGT 11.0 9.0 IU/L 0.0 - 65.0
520461 - Iron, Serum 100.0 114.0 ug/dL 40.0 - 155.0
520462 - AMYLASE Units/L 28 - 100
520463 - LIPASE Units/L 7 - 58
520464 - NH3 mcmol/L 15 - 56
520465 - URIC AC 5.6 mg/dL 4.8 - 8.7 3.7 - 8.6
520466 - Cholesterol, Total 164.0 162.0 mg/dL 100.0 - 199.0
520467 - Triglycerides 55.0 64.0 mg/dL 0.0 - 149.0
520468 -
520470 - ..
520471 - Comments:
520472 -
520473 - a. Test Performed at...
520474 - Health Testing Centers
520475 - 2760 W. OAKLAND PARK BLVD.
520476 - FORT LAUDERDALE FL 33311
520477 -
520478 -
520480 - ..
520481 - Notes on Electrolytes Lab
520482 -
520483 - Follow up ref SDS 49 G34G.
520484 -
520485 - 1. T Bilirubin 1.3................. ref SDS 0 015M
520486 -
520487 - Bilirubin 1.3 in lab today, remains 10% high after ending
520488 - Rosuvastatin 17 months ago on 121206 0900, ref SDS 26 OS5L,
520489 - indicating chornic side effects. This is 40% improvement
520490 - compared to prior Labcorp and VA labs, shown on 140203 1147.
520491 - ref SDS 49 G34G Declining T Bilirubin may indicate recovering
520492 - liver function with low dose Atorvorstatin 10mg and Ezetimibe
520493 - 10mg prescribed by VA on 131219 0930, ref SDS 44 6H6K, and
520494 - which was started on 131230 on receipt of Ezetimibe 10mg,
520495 - reported case study on 120101 0900. ref SDS 15 6A6H Improving
520496 - liver function may align with declining peripheral neuropathy
520497 - from most severe effects; there have been no symptoms for past
520498 - 9 months, since 130614, reported in case study on 120101 0900.
520499 - ref SDS 15 TSUY Prior to 130614, there were no episodes for
520500 - several months reported on 130402, ref SDS 15 RURT, until
520501 - episode occurred on 130210. ref SDS 15 PV8I Major peripheral
520502 - neuopathy both feet on 130107. ref SDS 15 8H5F
520504 - ..
520505 - Background on Rosuvastatin causing elevated T Bilirubin with
520506 - associated severe side effects is reported on 121206 0900,
520507 - ref SDS 26 NI9L, and further explained in the record on 121130
520508 - 0846. ref SDS 25 ER4K
520510 - ..
520511 - On 131017 1000 Doctor Egan explained patient history of
520512 - intermittant and mild peripheral neuropathy that correlates
520513 - with persistent elevated T Bilirubin in lab on 131015,
520514 - ref SDS 33 015M, and further reported with vitals, diet and
520515 - exercise since prior meeting at VA on 130603, see case study on
520516 - 120101 0900, ref SDS 15 X14N, suggests intervention is not
520517 - required at this time to improve recovery from side effects
520518 - taking Rosuvastatin. ref SDS 36 LV5J
520520 - ..
520521 - On 131017 1000 VA medical chart Progress Notes assessment
520522 - report doctor concerned about chronic hyperbilirubinemia.
520523 - ref SDS 36 PSXT
520525 - ..
520526 - 2. Potasium K 5.6 Elevated above range......... ref SDS 0 ZG5O
520527 -
520528 - This is an increase from 4.8 on prior Labcorp lab and 5.4 on VA
520529 - lab from 3 months ago, shown on 140203 1147. ref SDS 49 ZG5O
520531 - ..
520532 - Doctor Egan, referring cardiology physician at Martinez VA,
520533 - noted in a recent letter that meeting at VA Medical Center in
520534 - San Francisco on 140213 0830, ref SDS 51 GT7G, did not address
520535 - elevated potassium in labs performed by Labcorp and VA, shown
520536 - on 140203 1147. ref SDS 49 ZG5O Doctor Egan again notifies
520537 - that this condition of elevated potassium represents exposure
520538 - to "electrical problems" with the heart, reported on 140430.
520539 - ref SDS 52 UV5I Doctor Egan was notified that results of
520540 - follow up lab today on 140508, would be presented to VA Medical
520541 - Center in San Francisco, shown in letter on 140505 0936,
520542 - ref SDS 53 YV5T
520544 - ..
520545 - Doctor Egan was concerned last year about potasium (K) rising
520546 - above range for good health. He explained potasium effects
520547 - electrical signals to the heart, and so has significance for
520548 - CVD, reported during meeting at VA on 121206 0900. ref SDS 26
520549 - 6K56
520551 - ..
520552 - At that time on 121206, the doctor cited medication conflicts
520553 - as possibly causing elevated potasium. ref SDS 26 FI7L Doctor
520554 - Egan further considered dehydration (urination) caused by
520555 - Rosuvastatin may have skewed lab results for electrolytes on
520556 - 121130, and so ordered re-test. ref SDS 26 6K4J
520558 - ..
520559 - On 121212 0941 re-test lab reported Glucose 111, sodium 139,
520560 - and potasium (K) 4.6, all within range, ref SDS 27 KK9M,
520561 - correcting errors noted by Doctor Egan during meeting at VA on
520562 - 121206 0900. ref SDS 26 6K4J
520564 - ..
520565 - At this time, dehydration from increased urination combined
520566 - with hiking 22 miles yesterday, and another 11 miles this
520567 - moring before the blood draw, reported in case study on 120101
520568 - 0900, ref SDS 15 4G5I, might reconcile elevated potasium (K
520569 - 5.6).
520571 - ..
520572 - 3. Glucose 97...................... ref SDS 0 ZG5O
520573 -
520574 - Glucose near upper range 99 presents risk diabetes. Like
520575 - potassium, per above, ref SDS 0 KZ5O, glucose may be elevated
520576 - by dehydration taking statin medication, and by hiking 22 miles
520577 - yesterday and 11 miles this morning before the lab, reported in
520578 - case study on 120101 0900. ref SDS 15 4G5I
520579 -
520580 - [On 140514 0950 VA lab for HGBA1c 5.4 within range 4 - 6
520581 - seems to indicate no evident exposure for diabetes.
520582 - ref SDS 58 H66G
520584 - ..
520585 - [On 140515 2043 letter notifies VA Medical Center in San
520586 - Francisco that glucose, sodium and potassium are elevated
520587 - above expected levels in Labcorp Lab on 140508, and reminds
520588 - that Doctor Egan issued request for re-lab because elevated
520589 - potassium presents electrical problems for the heart, which
520590 - is at risk in this case based on CABG +4 on 091022.
520591 - ref SDS 61 YM75
520593 - ..
520594 - [On 140518 2120 follow up letter reports that since VA has
520595 - not issued notice to do Electrolyte (Chem Profile) lab to
520596 - check glucose, sodium and potassium, customer will not
520597 - report lab for blood draw prior to meeting with VA at
520598 - Medical Center in San Francisco on 140519 0830. ref SDS 62
520599 - DV4M
520601 - ..
520602 - [On 140518 0920 at 2242 Doctor Alba notifies customer to
520603 - defer follow up chem profile (electrolyte) labs to verify
520604 - glucose, sodium and potassium elevated in Labcorp Lab on
520605 - 140508, responding to Doctor Egan's request based on
520606 - potential for potassium to cause heart problems.
520607 - ref SDS 62 NY4F
520608 -
520609 -
520610 -
520611 -
520612 -
520613 -
520614 -
520615 -
520616 -
5207 -
SUBJECTS
Labcorp Lab Lipid Cholesterol 162 Stable with Atorvastatin 10mg Ezet
6903 -
690401 - ..
690402 - LDL-C 83 LDL-P 851 LDL Size Large Hike 900 Miles Weight Lose 15 Pounds
690403 -
690404 - Follow up ref SDS 49 IM9N, ref SDS 48 IM9N.
690405 -
690406 - Results today reported by Labcor using NMR technology align with
690407 - increased hiking and weight loss past 3.5 months, reported in case
690408 - study on 120101 0900, ref SDS 15 NC4N, and reflect changes in diet and
690409 - medication, reported on 140508, in the same study. ref SDS 15 UG6N
690410 -
690411 - [On 140510 2056 received letter from Health Testing Centers
690412 - transmitting report on lab results. ref SDS 55 4Q6I
690414 - ..
690415 - [On 140515 2043 VA notified consolidated test results show
690416 - progress lowering CVD risk with improved lipid management.
690417 - ref SDS 60 IM9N
690419 - ..
690420 - Prior LIPID PANEL 120509 1108. ref SDS 20 IM9N
690421 - Prior LIPID PANEL 120831 1525. ref SDS 21 IM9N
690422 - Prior LIPID PANEL 130228 1140. ref SDS 29 IM9N
690423 - Prior LIPID PANEL 130529 0818. ref SDS 31 IM9N
690424 - Prior LIPID PANEL 131015 0724, ref SDS 33 IM9N
690425 - Prior LIPID PANEL Labcorp, 140201 1159, ref SDS 48 IM9N
690426 - Prior LIPID PANEL, 140203 1147, ref SDS 49 IM9N
690428 - ..
690429 - LIPIDS
690431 - ..
690432 - LIPID Panel....2014 05 08 1149 140203 140201 131015 130529
690433 - Labcorp VA Labcorp VA VA VA Labcorp
690434 - NMR LipoProfile Results Results Results Results Results Units Range Range
690435 - LDL Particle Number
690436 - LDL-P 851.0 861.0 nmol/L < 1000
690437 - <ow < 1000
690438 - Moderate 1000 - 1299
690439 - Borderline High 1300 - 1599
690440 - High 1600 - 2000
690441 - Very High > 2000
690443 - ..
690444 - Lipids
690445 - CHOL 162 160 156 321 H 307 mg/dL Ref: <=200 < 200
690446 - TRIGLYC 59 47 68 109 85 mg/dL Ref: <=150 < 150
690447 - HDL-C 67 58 61 50 50 mg/dL Ref: >=40 >= 40
690448 - LDL-C 83 93 81 249 H 240 mg/dL Ref: <=160 < 100
690449 - LDL Dir mg/dL Ref: <=160
690450 - TRIG NF mg/dL Ref: <=150
690452 - ..
690453 - TG/HDL ratio........... 0.88 0.81 1.11 < 2.0
690455 - ..
690456 - LDL and HDL Particles
690457 - HDL-P (Total) 38.1 31.4 umol/L >= 30.5
690458 - Small LDL-P < 90.0 < 90.0 umol/L <=527.0
690459 - LDL Size 21.2 21.3 nm > 20.5
690461 - ..
690462 - --------------------------------------------------------
690463 - ** INTERPRETATIVE INFORMATION**
690464 - PARTICLE CONCENTRATION AND SIZE
690466 - ..
690467 - LDL AND HDL PARTICLES Percentile in Reference Population
690468 - HDL-P (total) High 75th 50th 25th Low
690469 - >34.9 34.9 30.5 26.7 <25.7
690470 - ..
690471 - Small LDL-P Low 25th 50th 75th High
690472 - <117 117 527 839 >839
690474 - ..
690475 - LDL Size <- Large (Pattern A)-> <- (Pattern B) ->
690476 - 23.0 20.6 20.5 19.0
690478 - ..
690479 - --------------------------------------------------------
690480 - Insulin Resistance/Diab. Risk
690481 - Large VLDL-P < 0.8 nmol/L <= 2.7
690482 - Small LDL-P < 90.0 nmol/L < 527
690483 - Large HDL-P 9.4 umol/L >= 4.8
690485 - ..
690486 - VLDL Size NOTES nm
690487 -
690488 - VLDL concentration too low to allow determination of VLDL
690489 - Size. Low VLDL concentration contributes minimally to the
690490 - LP-IR score.
690492 - ..
690493 - LDL Size 21.2 nm >= 20.8
690494 - HDL Size 9.8 nm >= 9.2
690495 -
690496 - Small LDL-P, LDL Particle Size, Large HDL-P VLDL Size, HDL
690497 - Size, HDL Particle, and LP-IR Score have been validated by
690498 - LipoScience but not cleared by US FDA; the clinical
690499 - utility of these tests has not been fully established.
690501 - ..
690502 - Insulin Resistance Score
690503 - LP-IR Score < 25.0 < 25.0 <= 45.0
690504 -
690505 - LP-IR Score is inaccurate if patient is non-fasting. The
690506 - LP-IR Score combines the information from Large VLDL-P,
690507 - Small LDL-P, Large HDL-P, VLDL Size, LDL Size and HDL Size
690508 - to give improved assessment of insulin resistance and
690509 - diabetes risk.
690511 - ..
690512 - INSULIN RESISTANCE MARKER
690513 -
690514 - <--Insulin Sensitive Insulin Resistant-->
690515 - Percentile in Reference Population
690516 -
690517 - Large VLDL-P Low 25th 50th 75th High
690518 - <0.9 0.9 2.7 6.9 >6.9
690520 - ..
690521 - Small LDL-P Low 25th 50th 75th High
690522 - <117 117 527 839 >839
690524 - ..
690525 - Large HDL-P High 75th 50th 25th Low
690526 - >7.3 7.3 4.8 3.1 <3.1
690528 - ..
690529 - VLDL Size Small 25th 50th 75th Large
690530 - <42.4 42.4 46.6 52.5 >52.5
690532 - ..
690533 - LDL Size Large 75th 50th 25th Small
690534 - >21.2 21.2 20.8 20.4 <20.4
690536 - ..
690537 - HDL Size Large 75th 50th 25th Small
690538 - > 9.6 9.6 9.2 8.9 < 8.9
690540 - ..
690541 - Insulin Resistance Score
690542 - LP-IR Score Low 25th 50th 75th High
690543 - <27 27 45 63 >63
690544 -
690546 - ..
690547 - Cardiovascular Risk Assessment
690549 - ..
690550 - Interpretation
690552 - ..
690553 - For Interpretations, please refer to Litholink CDS Patient
690554 - Report.
690556 - ..
690557 - PDF Image
690559 - ..
690560 - 01 SO Kelli Chase, MD
690561 - Labcorp San Diego
690562 - 13112 Evening Creek Dr So Ste 200 San Diego, CA
690563 - 92128-4108
690565 - ..
690566 - 02 S7 Deanna Franke, PhD
690567 - Liposcience Inc
690568 - 2500 Sumner Blvd, Raleigh, NC 27616-3235
690570 - ..
690571 - 03 S7 Mitchell Laks, PhD
690572 - Litholink Corporation
690573 - 2255 W Harrison Street Ste B, Chicago, IL 60612-4670
690575 - ..
690576 - For inquiries, the physician may contact Branch: 800 762 4344
690577 - Lab: 858 668 3700
690579 - ..
690580 - Comments:
690581 -
690582 - a. Test Performed at...
690583 - Health Testing Centers
690584 - 2760 W. OAKLAND PARK BLVD.
690585 - FORT LAUDERDALE FL 33311
690587 - ..
690588 - b. Medical Director's Note: On November 12, 2013, the ACC/AHA
690589 - released new guidelines on cholesterol treatment in adults
690590 - (Stone NJ et al. 2013 ACC/AHA guideline on the treatment of
690591 - blood cholesterol to reduce atherosclerotic cardiovascular
690592 - risk in adults: a report of the American College of
690593 - Cardiology/American Heart Association Task Force on
690594 - Practice Guidelines. Circulation. 2013; 00:000-000.) The
690595 - new guidelines do not make a recommendation for or against
690596 - use of LDL-C or non-HDL-C targets, but instead identify
690597 - patient groups who would benefit from statin therapy.
690598 - Until a consensus has been reached, the suggestions in this
690599 - report continue to reflect the ATP III guidelines. For
690600 - Interpretations, please refer to Litholink CDS Patient
690601 - Report.
690603 - ..
690604 - c. VA Evaluation for LDL-CHO:
690605 -
690606 - RISK CATEGORY LDL GOAL
690607 - CHD and CHD risk equivalents <100 mg/dL
690608 - Multiple (2+) risk factors <130 mg/dL
690609 - 0-1 risk factor <160 mg/dL
690611 - ..
690612 - HDL Chol. greater than/equal to 60 mg/dL counts as
690613 - "negative" risk factor; its presence removes 1 risk factor
690614 - from the total count.
690616 - ..
690617 - Ref: Adult Treatment Panel III (ATP III) JAMA 5/16/01 Vol.
690618 - 285 #19.
690620 - ..
690621 - d. Format and scope Labcorp lab report changed by adding
690622 - metrics on VLDL, above, ref SDS 0 S16F, that was omitted in
690623 - prior Labcorp report for blood draw on 140201 1159.
690624 - ref SDS 48 WR9H
690626 - ..
690627 - Analysis....
690628 -
690629 - 1. LDL-P 851, ref SDS 0 U45J, represents lower CVD risk and
690630 - improving lipid management. LDL-C 83 increased 2 points from
690631 - prior lab on 140201. It remains low concordant with LDL-P, but
690632 - moving toward discordance. Research indicates healthiest
690633 - cardiovascular condition occurs with lowest risk for CVD, when
690634 - lipids are discordant, with LDL-P low and LDL-C high, shown in
690635 - the record on 131125 0005. ref SDS 41 FI3G
690637 - ..
690638 - VA published goal for LDL-C <= 160; Labcorp published goal
690639 - LCL-C < 100. ref SDS 49 5C7M New AHA guidelines show LDL-C <
690640 - 190, reported on 131112 1422. ref SDS 39 HT87
690642 - ..
690643 - NMR test lists LDL-P < 1600 for "borderline" CVD high risk, and
690644 - that below 1000, is "low," meaning minimal risk for CVD.
690645 - ref SDS 49 U45J Thus, LDL-P 851 in this test presents low risk
690646 - for CVD. Research on 131125, lists LDL-P < 700 may be a better
690647 - target to manage CVD risk. ref SDS 41 WY9H The same research
690648 - also cites LDL-P < 1000 for evaluating CVD risk, similar to NMR
690649 - test today. ref SDS 41 OQ9N
690651 - ..
690652 - When can patients be confident LDL-P < 700, 600, 200 - is low
690653 - enough to work on other aspects of daily life?
690655 - ..
690656 - 2. LDL-P 851 in Labcorp test today on 140508, correlates with
690657 - TG/HDL ratio 59/67 = 0.88. ref SDS 0 5C7M Research indicates
690658 - TG/HDL ratio correlates to LDL-P vaulations produced by NMR
690659 - testing, reported on 131125 0005. ref SDS 41 666G
690661 - ..
690662 - 3. Resting heart rate getting up in the morings has fallen below
690663 - 50. Blood pressure varies - averages about 115 65. After
690664 - hikes about 105 55. Systalic on occassion falls below 100.
690665 - Dystalic has fallen below 50 - e.g., see Monday 140428 reported
690666 - in case study on 120101 0900. ref SDS 15 CB6N
690668 - ..
690669 - 4. LDL-P 851 and HDL 67 and Triglycerides 59 on 140508, indicate
690670 - low risk for CVD, per above analysis, ref SDS 0 RV5M, and may
690671 - align with hiking 22 miles yesterday on 140507, and 11 miles
690672 - this morning at 0400 (see again case study - ref SDS 15 4G5I),
690673 - before doing the blood draw later this morning at 1149.
690674 - ref SDS 0 U45J
690676 - ..
690677 - 5. Lipid favorable results in NMR test on 140201, and follow up
690678 - test at VA on 140203, occurred concurrent with...
690679 -
690680 - a. Hiking 888 miles since prior lab on 140201, reported in
690681 - case study 120101 0900, ref SDS 15 P36G, including 22 miles
690682 - the day before, and another 11 miles the morning before
690683 - blood draw, and recommended in research on 131125 0005.
690684 - ref SDS 41 QP9F including regular aerobic exercise to lower
690685 - triglycerides. ref SDS 41 JV5O
690687 - ..
690688 - b. Weight - hit 165 on 140420, and held for 3 days, shown in
690689 - case study on 120101 0900. ref SDS 15 TO6O This is
690690 - continuing challenge bouncing around from over 200 in 2011,
690691 - but varied significantly.
690693 - ..
690694 - c. Low-carbohydrate diet lowers triglycerides (TG 59 in
690695 - Labcorp test, per above, ref SDS 0 5C7M), which together
690696 - with higher HDL 67 (TG/HDL ratio < 2) combine to lower
690697 - LDL-P, cited in research on 131125 0005. ref SDS 41 QP9F
690699 - ..
690700 - d. Chia seeds added to diet on 131125, reported in case study
690701 - on 120101 0900, ref SDS 15 746M, and recommended by Karen
690702 - at VA on 131121 0930. ref SDS 40 NQ37
690704 - ..
690705 - e. Orange juice added to diet on 131125, based on study
690706 - indicating HDL increase 21%, ref SDS 41 R48K, as reported
690707 - to VA in letter on 140114 0845. ref SDS 45 218O
690709 - ..
690710 - f. Atorvastatin 10 mg reduced 131230, and added Ezetimibe 10
690711 - mg reported in case study, ref SDS 15 6A6H
690713 - ..
690714 - Research cites studies that report Atorvastatin 10 mg +
690715 - Ezetimibe 10 mg achieves LDL < 70, and favorably changes
690716 - triglycerides and HDL by 5%, reported on 131125 0005.
690717 - ref SDS 41 CO45 While low LDL < 70 conflicts with goal of
690718 - "discordance" that lowers health risk for arterialsclorosis
690719 - and CVD when LDL-P low and LDL-C high, shown in research on
690720 - 131125 0005, ref SDS 41 FI3G, even "concordant" results
690721 - today are good news.
690723 - ..
690724 - Since prior lab on 140201, until lab at VA today on 140508,
690725 - case study shows on 120101, ref SDS 15 E47L, patient has
690726 - taken...
690727 -
690728 - 1. Atorvastatin............... 900 mg
690729 - 2. Ezetimibe.................. 900 mg
690730 -
690732 - ..
690733 - Lipid History Trend Analysis
690734 -
690735 - Follow up ref SDS 25 W25L.
690736 -
690737 - Small LDL LP-IR
690738 - Collection DT CHOL TRIGL HDL LDL-C LDL-P HDL-P LDL-P SIZE SCORE
690739 - 05/08/2014 11:49 162 59 67 83 851 38.1 < 90 21.2 < 25 ..... ref SDS 0 BE6O
690740 - 02/03/2014 12:28 160 H 47 58 93 ......................................... ref SDS 49 BE6O
690741 - 02/01/2014 12:31 156 68 61 81 861 31.4 < 90 21.3 < 25 ..... ref SDS 48 BE6O
690742 - 10/15/2013 08:25 321 H 109 50 249 H ......................................... ref SDS 33 BE6O
690743 - 05/29/2013 08:18 307 H 85 50 240 H ......................................... ref SDS 29 BE6O
690744 - 02/28/2013 08:39 310 H 73 47 248 H ......................................... ref SDS 29 BE6O
690745 - 11/30/2012 10:01 173 53 57 105 ......................................... ref SDS 25 BE6O
690746 - 08/31/2012 15:25 176 94 47 110 ......................................... ref SDS 21 U89N
690747 - 05/09/2012 11:24 158 76 49 94 ......................................... ref SDS 20 U89N
690748 - 02/09/2012 11:18 285 82 41 228 H ......................................... ref SDS 16 2A4G
690749 - 11/17/2011 14:27 260 84 43 200 H ......................................... ref SDS 14 2A4G
690750 - 07/27/2011 12:58 163 81 45 102 ......................................... ref SDS 10 E19L
690751 - 12/07/2010 09:17 151 41 47 96 ......................................... ref SDS 9 E19L
690752 - 07/21/2010 08:54 261 H 87 35 L 209 H ......................................... ref SDS 5 E19L
690753 - 06/10/2010 10:33 217 H 83 36 L 164 H ......................................... ref SDS 4 QV4F
690754 - * 12/14/2009 11:10 241 H 136 44 170 H ......................................... 100928 0706, ref SDS 6 VW6J
690755 - 08/13/2009 15:09 233 H 118 30 L 179 H ......................................... 100610 1046, ref SDS 4 U45G
690756 - 06/16/2006 10:59 238 H 68 32 L 192 H ......................................... 091002 0900, ref SDS 2 LJ5H
690757 -
690758 - [...140515f2043ref SDS 60 YM56
690759 -
690760 - * Lab at VA San Francisco Medical Center reported on 100928 0706.
690761 - ref SDS 6 VW6J
690763 - ..
690764 - Research on cholesterol reported on 091002 0900. ref SDS 2 2F8K
690766 - ..
690767 - On 131125 0005 research found ezetimibe (zetia) mg added to
690768 - Atorvastatin 20 mg yielded after 6 weeks significantly greater changes
690769 - to lipids than taking Atorvastatin in higher doses, e.g., 20 or 40 mg.
690770 - ref SDS 41 CO56
690772 - ..
690773 - On 131125 0005 research found discordance LDL-P low and LDL-C high
690774 - lipid panel HDL 65 TG 77 healthy patient profile with LDL 246.
690775 - ref SDS 43 MN98 Discordance with LDL-P low and LDL-C high is lowest
690776 - risk for CVD, arterialsclorosis. 131125 0005, ref SDS 41 FI3G
690777 -
690779 - ..
690780 - Coronary CTA or IVUS Test Athereosclerosis Plaque 4 Years After CABG
690781 - Athereosclerosis Plaque 4 Years After CABG Coronary CTA or IVUS Test
690782 -
690783 - On 131125 0005 research further found radiology imaging tests can
690784 - evaluate level of plaque build up resulting from elevated cholesterol.
690785 - ref SDS 42 N73K Radiology imaging technologies are Coronary CT
690786 - angiography - CTA - and Intravascular ultrasound - IVUS. ref SDS 41
690787 - KZ8O
690789 - ..
690790 - Lipid history and particularly the past 6 months with HDL > 60 and
690791 - Triglycerides < 100, ref SDS 0 W25L, indicates patient may have change
690792 - body chemestry sufficient to cause rapid regression of atherosclerosis
690793 - plaque, cited in research on 131125 0005. ref SDS 41 RA7K Research
690794 - indicates that favorable lipid profile, weight loss, and production of
690795 - EPC in the bone marrow, all stimulated by exercise, drives regression
690796 - of plaque. ref SDS 41 XY7L
690797 -
690798 -
690799 -
690800 -
690801 -
690802 -
690803 -
690804 -
690805 -
690806 -
690807 -
690808 -
690809 -
6909 -
SUBJECTS
VA Lab Cardiac Enzymnes Creatine Kinase CK 149 Range 36 340 Measures
7503 -
750401 - ..
750402 - Myopathy Muscle Pain Side Effects Simvistatin Decline
750403 -
750404 - Follow up ref SDS 49 D26G, ref SDS 48 D26G.
750405 -
750406 - Prior Cardiac Enzymes Profile on 120209 1118. ref SDS 16 D26G
750407 - Prior Cardiac Enzymes Profile on 120509 1108. ref SDS 20 D26G
750408 - Prior Cardiac Enzymes, 131015 0724, ref SDS 33 D26G
750409 - Prior Cardiac Enzymes Profile VA on 140203 1147. ref SDS 49 NX6G
750411 - ..
750412 - This test not performed by Labcorp with blood draw on 140508...
750413 -
750414 - CARDIAC ENZYMES
750415 -
750416 - DATE 2014 05 08 1149 140203 131015 120509
750417 - Labcorp VA VA VA
750418 - PLASMA Results Results Results Results Units Range
750419 - CK 149 110 152 IntUnits/L 36 - 340
750420 - TRPONIN ng/ml 0 - 0.07
750421 - CK-MB ng/ml 0.6 - 3.5
750422 - MYOGLOB ng/ml 20 - 82
750424 - ..
750425 - a. CK or CPK test not performed by Labcorp
750427 - ..
750428 - b. TEST PERFORMED BY VAMC SACRAMENTO, 10535 HOSPITAL WAY,
750429 - MATHER CA.
750431 - ..
750432 - Research on 111013 explains Creatine Kinase CK, relates to muscle
750433 - disorders caused by cholesterol medications with statins. 111013 1404,
750434 - ref SDS 13 J54K
750436 - ..
750437 - CK lab may align with reduced side effects of muscle pain in left
750438 - shoulder.
750439 -
750440 -
750441 -
750442 -
750443 -
750444 -
7505 -
SUBJECTS
HGBA1C 5.5 Range 4.1-6.2 Diabetes Negative Laboratory Blood Test Cro
A403 -
A40401 - ..
A40402 - HGBA1c Diabetes Blood Test
A40403 - Diabetes Blood Test HGBA1c
A40404 -
A40405 - Follow up ref SDS 49 9F4O, ref SDS 48 9F4O.
A40406 -
A40407 - Prior HGBA1c Profile on 100721 0800. ref SDS 5 IL4N
A40408 - Prior HGBA1c Profile on 101207 0906. ref SDS 9 IL4N
A40409 - Prior HGBA1c Profile on 131015 0724. ref SDS 33 9F4O
A40410 - Prior HGBA1c Profile on 140203 1147. ref SDS 49 9F4O
A40412 - ..
A40413 - This test not performed by Labcorp with blood draw on 140508...
A40414 -
A40415 - HGBA1c
A40416 -
A40417 - HGBA1c.........2014 05 08 1149 140203 131015 101207
A40418 - Labcorp VA VA VA
A40419 - BLOOD Results Results Results Results Units Range
A40420 - HGBA1c 5.5 5.5 5.7 % 4.1 - 6
A40421 - eAG 111 111 mg/dL 74.0 - 118
A40423 - ..
A40424 - Comments:
A40425 -
A40426 - a. Labcorp did not perform HGBA1c lab
A40427 -
A40428 - b. TEST PERFORMED BY VA MARTINEZ, 150 MUIR ROAD, MARTINEZ CA.
A40429 -
A40430 - eAG = Calculated Estimated Average Daily Glucose and may be
A40431 - easier for patients to understand than an A1c result.
A40432 - Calculation: 28.7 x HGBA1c - 46.7
A40434 - ..
A40435 - Ordering Provider: Harkesh S. Sandhu MD
A40436 - Report Released: Oct 15, 2013 @ 1309
A40438 - ..
A40439 - Reporting Lab: MARTINEZ OPC/CREC
A40440 - 150 MUIR ROAD MARTINEZ, CA 94553-4668
A40442 - ..
A40443 - Performing Lab: MARTINEZ OPC/CREC
A40444 - 150 MUIR ROAD MARTINEZ, CA 94553-4668
A40445 -
A40447 - ..
A40448 - This test for diabetes was ordered by Doctor Abrams during a meeting
A40449 - at the San Francisco VA Medical Center on 130227 0930. ref SDS 28 8T5L
A40450 - However, it is not reported for the lab performed the next day on
A40451 - 130228 1140, ref SDS 29 RP4N, nor in the follow up lab 3 months later
A40452 - on 130529 0818. ref SDS 31 RP4N
A40454 - ..
A40455 - HGGA1c was performed previously on 101207 0906, ref SDS 9 IL4N, and 5
A40456 - months earlier on 100721 0800. ref SDS 5 IL4N
A40458 - ..
A40459 - Labcorp test showing LP-IR Score < 25.0, indicating very low risk of
A40460 - diabetes, reported today, above. ref SDS 0 TU6L
A40461 -
A40462 -
A40463 -
A40464 -
A40465 -
A40466 -
A40467 -
A40468 -
A40469 -
A405 -